Lower Urinary Tract Symptoms Patients Research Articles

Thai traditional massage modulates urinary MCP-1 and relevant inflammatory biomarkers in lower urinary tract symptom patients.

Lower urinary tract symptoms (LUTS) resulting from benign prostatic hyperplasia are a common complaint among elderly men worldwide. Our previous study reported alleviative efficacy of Thai traditional massage (TTM) on LUTS patients. However, underlying mechanism at cellular level remained elusive. Herein, we investigated the effect of TTM on urinary monocyte chemotactic protein-1 (MCP-1) and associative inflammatory biomarkers. Forty-three patients were randomized into two groups: Tamsulosin (n=23) and TTM (n=20). The urinary MCP-1 and interferon-gamma (IFN-γ) levels as well as gene expression levels of MCP-1, Chemotactic protein receptor 2b (CCR2b), IFN-γ, interleukin-1 beta (IL-1β), and transforming growth factor-beta 1 (TGF-β1) were evaluated before and after a four-week treatment. The urinary MCP-1 and IFN-γ levels as well as gene expression levels of MCP-1, CCR2b, IFN-γ, IL-1β, and TGF-β1 were evaluated before and after treatment with Tamsulosin or TTM group. Urinary MCP-1 and IFN-γ levels and the expression levels of five genes from sedimented urine samples were measured using Enzyme-Linked Immunosorbent Assay and quantitative Reverse Transcription Polymerase Chain Reaction, respectively. We observed significant (p<0.05) reduction in the ratio of urinary MCP-1 and creatinine (Cr); MCP-1/Cr levels in subjects given only TTM. There were no significant differences (p<0.05) in IFN-γ/Cr levels in both groups. TTM group down-regulated the expression of IFN-γ whereas up-regulated IL-1β and TGF-β1 mRNA. Our findings suggested TTM had alleviative effects in LUTS patients, which were partially mediated by a reduction of urinary inflammatory cytokines and inflammatory gene expression.

High prevalence of frailty in patients with lower urinary tract symptoms.

Older adults are more likely to be frail and have a high prevalence of urological diseases such as lower urinary tract symptoms (LUTS). The purpose of this study was to clarify the prevalence and characteristics of comorbid frailty in older patients with urological diseases. We retrospectively reviewed the medical records of 970 patient who visited the Department of Urology, Juntendo University Hospital between October 2015 and October 2016. Patients were selected who were 65 years of age or older and were being evaluated by the Kihon Checklist (KCL) to assess frailty. We examined the prevalence of comorbid frailty in urological diseases, identified factors associated with comorbid frailty in urological diseases, and examined KCL scores in urological diseases with a high prevalence of frailty. A total of 405 participants were included. Of these, 21.7% were frail, 20.5% were pre-frail, and 57.8% were robust. LUTS, overactive bladder, and neurogenic bladder showed a statistically significant relationship with comorbid frailty, with high frailty prevalence rates of 44/140 (31.4%), 19/36 (52.8%), and 4/6 (66.7%), respectively. Factors related to the comorbid frailty according to multivariate analysis were female sex (P = 0.001), older age (P < 0.001), and LUTS (P < 0.033). Of the KCL subscale scores, instrumental activities of daily living (P = 0.008), physical function (P < 0.001), oral function (P = 0.008), housebound (P = 0.009), and depression (P = 0.034) were higher in LUTS patients than in non-LUTS patients. Among patients with urological diseases, those with LUTS were found to have a high prevalence of frailty. Geriatr Gerontol Int 2023; 23: 609-615.

Polyuria in patients with lower urinary tract symptoms: Prevalence and etiology.

Patients with lower urinary tract symptoms (LUTS) can be subcategorized into polyuria, normal or oliguria groups. Polyuria may be caused by pathologies including diabetes mellitus (DM), chronic kidney disease (CKD), diabetes insipidus (DI), or primary polydipsia (PPD). While fluid restriction is appropriate for some, doing so in all may result in serious complications. This study investigates the prevalence of these pathologies in LUTS patients with polyuria. Two databases were retrospectively queried for men and women who filled out a lower urinary tract symptom score (LUTSS) questionnaire, 24-hbladder diary (24HBD) and were polyuric (>2.5 L/day). Patients were divided into four groups: poorly controlled DM, DI, anCKD grade 3 and PPD. One-way analysis of variance compared 24HBD and LUTSS questionnaires. Pearson correlation examined LUTSS and bother with 24-h voided volume (24 HVV), maximum voided volume (MVV) and total voids. Among 814 patients who completed a 24HBD, 176 had polyuria (22%). Of the patients with complete data, 7.8% had poorly-controlled DM, 3.1% had DI, 4.7% had CKD grade 3% and 84.4% had PPD. Amongst the four different sub-groups, significant differences were seen in 24 HVV (p < 0.001), nocturnal urine volume (NUV) (p < 0.001), MVV (p = 0.003), daytime voids (p = 0.05), nocturnal polyuria index (NPi) (p < 0.001) and nocturia index (Ni) (p = 0.002). Significance was also seen between LUTSS and bother subscore (r = 0.68, p < 0.001), LUTSS and total voids (r = 0.29, p = 0.001) and bother sub-score and total voids (r = 0.21, p = 0.019). 22% of patients with LUTS were found to have polyuria based on a 24HBD. Within this cohort, four sub-populations were identified as being demonstrating statistically significant differences in 24 HVV, NUV, MVV, daytime voids, NPi and Ni. Identifying the underlying etiology of polyuria should be carried out to safely treat patients with LUTS.

Immunoglobulin G4-related disease diagnosed by prostate biopsy: a case report

BackgroundImmunoglobulin G4-related disease is characterized by swelling of various organs throughout the body and nodules/hypertrophic lesions. However, its cause remains unknown. We report a case of immunoglobulin G4-related disease that was diagnosed based on the histopathological findings of prostate biopsy.Case presentationA 72-year-old Japanese man had been treated by a nearby doctor for hypertension, but subsequently developed lower urinary tract symptoms and was prescribed an α1 blocker for 1 year. However, the patient was subsequently referred to our department because his symptoms did not improve. Prostate-specific antigen was 1.258 ng/ml; however, the nodule was palpable in the right lobe on digital rectal examination, and magnetic resonance imaging suggested Prostate Imaging and Reporting and Data System category 3. Therefore, transrectal prostate needle biopsy (12 locations) under ultrasound was performed. Histopathological examination revealed no malignant findings, although infiltration of lymphocytes and plasma cells, and partial fibrosis were observed. No remarkable findings of obstructive phlebitis were observed. Immunoglobulin G4-related disease was suspected, and immunoglobulin and immunoglobulin G4 immunostaining was performed. Immunoglobulin G4 positive plasma cells were observed in a wide range, immunoglobulin G4 positive cells were noted at > 10 per high-power field, and the immunoglobulin G4 positive/immunoglobulin G positive cell ratio was > 40%. Serum immunoglobulin G4 levels were high at 1600 mg/dl. Enhanced abdominal computed tomography findings suggested periaortitis. Additionally, multiple lymphadenopathies were observed around the abdominal aorta. The patient was accordingly diagnosed with immunoglobulin G4-related disease definite, diagnosis group (definite). We proposed steroid treatment for periaortic soft tissue lesions and lower urinary tract symptoms; however, the patient was refused treatment. A computed tomography scan 6 months after diagnosis revealed no changes in the soft tissue lesions around the aorta. Follow-up computed tomography examinations will be performed every 6 months.ConclusionIf immunoglobulin G4-related disease is suspected and a highly invasive examination is required for histopathological diagnosis, this can be performed by a relatively minimally invasive prostate biopsy for patients with lower urinary tract symptoms. Further evidence is needed to choose an optimal candidate for prostate biopsy for lower urinary tract symptoms patients with suspicion of immunoglobulin G4-related disease. For patients with lower urinary tract symptoms with immunoglobulin G4-related disease or a history, performing a prostate biopsy may avoid unnecessary treatment. However, if steroid therapy is ineffective, surgical treatment should be considered.

MP18-03 PHENOTYPING PATIENTS WITH POLYURIA

You have accessJournal of UrologyCME1 May 2022MP18-03 PHENOTYPING PATIENTS WITH POLYURIA George Fisch, Alexander Fang, Connelly Miller, Claire Choi, Thomas Monaghan, Edward Smith, Learta Prishtina, Jeffrey Weiss, and Jerry Blaivas George FischGeorge Fisch More articles by this author , Alexander FangAlexander Fang More articles by this author , Connelly MillerConnelly Miller More articles by this author , Claire ChoiClaire Choi More articles by this author , Thomas MonaghanThomas Monaghan More articles by this author , Edward SmithEdward Smith More articles by this author , Learta PrishtinaLearta Prishtina More articles by this author , Jeffrey WeissJeffrey Weiss More articles by this author , and Jerry BlaivasJerry Blaivas More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002551.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Patients with lower urinary tract symptoms (LUTS) may be subcategorized based on urinary output into polyuria, normal or oliguria groups as demonstrated by Blaivas et al (Can J Urol. 2021 Jun) and Clemens et al (Neurourol Urodyn., 2020 Apr). Polyuria may be caused by several pathologic conditions including diabetes mellitus (DM), chronic kidney disease (CKD), diabetes insipidus (DI), or primary polydipsia (PPD). While fluid restriction is appropriate for the majority of patients, doing so in all may result in serious complications. This study investigates the prevalence of these pathologic conditions in LUTS patients with polyuria. METHODS: Two lower urinary tract databases were retrospectively queried to identify men and women presenting with LUTS who filled out the validated Lower Urinary Tract Symptom Score (LUTSS) questionnaire (Blaivas et al, Can J Urol 2015 Oct), a 24-hour bladder diary on a mobile app* or on paper, and met criteria for polyuria (>2.5 L/day). Patients were divided into four groups: poorly controlled DM, DI, CKD grade 3, and PPD. A one-way ANOVA was performed to compare groups and Pearson correlation was run examining the relationship between LUTSS and bother with 24 HVV, MVV and total voids. *weShare® by Symptelligence Medical Informatics.com. RESULTS: Among 814 total patients presenting with a chief complaint of LUTS, 146 (18%) men and women completed 24 HBD and LUTSS questionnaires and met criteria for polyuria. 7.8% had poorly-controlled DM, 3.1% had DI, 4.7% had CKD grade 3 and 84.4% had PPD. Amongst groups, statistically significant differences were seen in measurements of 24 HVV, NUV, MVV, Daytime Voids, NPi, and Ni. A statistically significant relationship was seen between LUTSS and bother score, LUTSS and total voids, and bother and total voids. CONCLUSIONS: 18% of the patients with LUTS in this series were found to have polyuria based on a 24HBD. Within this cohort, four sub-populations were phenotyped demonstrating significant differences in 24HVV, NUV, MVV, daytime voids, NPi and Ni. Identifying the underlying etiology of polyuria should be carried out to safely treat patients with LUTS. Source of Funding: Institute for Bladder and Prostate Research © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e296 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information George Fisch More articles by this author Alexander Fang More articles by this author Connelly Miller More articles by this author Claire Choi More articles by this author Thomas Monaghan More articles by this author Edward Smith More articles by this author Learta Prishtina More articles by this author Jeffrey Weiss More articles by this author Jerry Blaivas More articles by this author Expand All Advertisement PDF DownloadLoading ...

Evaluation of pedometer use in men with lower urinary tract symptoms: a randomized clinical trial.

To assess the effect of a pedometer use in men aged between 50 and 59years presenting lower urinary tract symptoms (LUTS). A single-center, not blind clinical trial with two parallel groups and equal randomization was performed with 38 men aged 50-59years with LUTS. All patients received guidance and encouragement to physical activity practice. Only the intervention group received a Pedometer with a goal of 10,000 steps/day. After a period of 12weeks, the groups were compared through the following variables: number of steps/day, IPSS score, flexibility, anthropometric values and Maximum Oxygen Consumption (VO2max). The number of steps per day in the intervention group was 9753 ± 1549 compared to 6212 ± 1152 in the control group (p = 0.004). Pedometer use efficacy was a 50% risk reduction of not achieve the goal of 10,000 steps per day. Regarding IPSS score, the intervention group achieved lower scores (6.95 ± 2.85 vs. 10.16 ± 3.23, p = 0.007). Pedometer use efficacy was a 94% risk reduction of not achieve more than 30% reduction in IPSS score. In VO2max, the intervention group performed better than the control group (34.84 ± 3.25 vs. 32.58 ± 6.89; p = 0.011). There was no difference in flexibility and anthropometric values between the groups. The use of pedometer in LUTS patients provided an increase in the number of steps/day, a decrease in LUTS score and an improvement in VO2max measure. Trial url: www.ensaiosclinicos.gov.br/rg/RBR-4vynk5/ . Register Number: RBR-4vynk5 .

Refractory lower urinary tract symptoms in patients with lumbar disc hernia relieved by non-surgical treatment

Refractory lower urinary tract symptoms (LUTS) coexisting with lumbar disc hernia (LDH) have been shown to resolve following LDH surgery, implying that LDH causes these LUTS. The purpose of this study was to report outcomes in patients with refractory LUTS and LDH following non-surgical treatment targeting LDH. A retrospective cohort study was conducted using outpatient data collected at Tongji Hospital, China, between 2016 and 2018. This study included 131 adult patients with refractory LUTS and LDH. Patients were stratified into two groups. Group A underwent non-surgical treatment for LDH plus pharmacological treatment for LUTS. Group B underwent only pharmacological treatment for LUTS. The International Prostate Symptom Score (IPSS), the IPSS quality of life (QoL) score, and uroflowmetry were used to evaluate outcomes. In group A, following treatment, the maximum flow rate (Qmax) increased by 3.92ml/s (p < 0.001), the IPSS reduced by 5.99 points (p < 0.001), and the QoL score decreased by 1.51 points (p < 0.001). In group B, the Qmax increased by 0.09ml/s (p = 0.833), the IPSS reduced by 0.72 points (p = 0.163), and the QoL score decreased by 0.07 points (p = 0.784). LUTS can be relieved by a combination of pharmacological treatment for LUTS and non-surgical treatment for LDH in some refractory LUTS patients with LDH. MRI is recommended for these patients.

Lower urinary tract symptoms and health-related quality of life in Hong Kong primary care: a cross-sectional study.

To estimate the prevalence of lower urinary tract symptoms (LUTS) in primary care using the International Continence Society symptom definition; to evaluate the association between LUTS and health-related quality of life (HRQOL); and to evaluate the treatment gaps. Patients aged 40 and above were randomly recruited in a Hong Kong public primary care. Patients were asked (i) how often they experienced 18 individual LUTS during the past 4weeks and (ii) whether they had sought treatments for their LUTS. The 12-Item Short Form Health Survey version 2 (SF-12 v2) and the modified Incontinence Impact Questionnaire-Short Form (IIQ-7) were used to measure HRQOL. 500 patients completed the survey. 75.8% of the patients had at least one LUTS "at least sometimes", with patients with a combination of storage, voiding, and post-micturition symptoms being the most prevalent (22.2%), followed by a combination of voiding and storage symptoms (14%). Only 14% of LUTS patients had sought treatments for their LUTS. LUTS was associated with a negative effect in all domains of the SF-12 v2 and IIQ-7 and patients with a combination of storage, voiding, and post-micturition symptoms had the worst HRQOL. Finally, having a combination of storage, voiding, and post-micturition symptoms and poorer HRQOL were factors associated with having sought treatments for LUTS. A high prevalence of LUTS but low treatment-seeking rates implied possible unmet needs of LUTS patients in primary care, suggesting the potential for more active interventions to alleviate the negative impact of LUTS on patients' HRQOL.

Correlation of Erectile Dysfunction and Lower Urinary Tract Symptoms among Men at Urology Clinic of a Tertiary Care Institute in South-East Nigeria

Introduction: Available literature suggests an association between Lower Urinary Tract Symptoms (LUTS) and sexual dysfunction especially Erectile Dysfunction (ED). LUTS, either alone or in combination with ED, represents a considerable problem for ageing men. An understanding of correlation between LUTS and ED in these ageing men will be useful in their routine care. Aim: To determine the incidence of ED and its correlation with LUTS in adult male patients attending the Urology clinic in a Tertiary Care Hospital. Materials and Methods: This was a cross-sectional study of 110 consecutive patients with LUTS recruited from the urological clinic. The data were collected, while ED and LUTS were assessed with the 5-Item Version of the International Index of Erectile Function (IIEF-5) and International Prostate Symptom Score (IPSS) questionnaire forms respectively. Findings were subjected to linear regression and Pearson’s chi-square tests, using Statistical Package for Social Sciences (SPSS) version 17. Results: The mean age of patients was 65.8±7.95 years. The incidence of ED among LUTS patients was 63.6%. There was positive correlation between ED scores and voiding phase, filling-storage phase and total LUTS scores. The severity of ED and graded LUTS score revealed no significant association between the severity of ED and that of voiding phase and filling-storage phase LUTS. Conversely, severity of ED was significantly related to the severity of total LUTS score. Conclusion: ED is common amongst adult patients with LUTS. Its severity worsens with worsening LUTS. The management of patients with LUTS should therefore involve evaluation and treatment for ED. This calls for increased awareness of these conditions to both the doctor and the patient.

Change of Detrusor Contractility in Patients with and without Bladder Outlet Obstruction at Ten or More Years of follow-up

To analyze the change of detrusor contractility by investigating urodynamic characteristics with long term follow-up. This study retrospectively reviewed 166 lower urinary tract symptoms patients without bladder outlet obstruction (BOO) and 63 patients with BOO who underwent repeated urodynamic studies at the first time and more than 10 years later. The urodynamic parameters, bladder contractility index (BCI), and BOO index (BOOI) were compared before and after. As time goes by, detrusor pressure at maximum flow rate (PdetQmax) significantly decreased and post-void residual (PVR) volume significantly increased in both men and women. Full sensation, urge sensation, voided volume, and BCI significantly decreased. We also compared men with and without BOO, PdetQmax, maximum flow rate (Qmax), voided volume, and BCI all significantly decreased in both groups without difference. PVR increased greater in men with BOO after >10 years significantly (p = 0.036). Women with detrusor overactivity (DO) under antimuscarinic showed no significant BCI change compared to patients without DO (p = 0.228). Detrusor contractility decreases in men and women after >10 years of follow-up. However, this finding suggests that patients with BOO or DO under adequate medical treatment, detrusor contractility is not aggravated over 10 or more years of follow-up.

Lower urinary tract symptoms impair the quality of life in maintenance hemodialysis patients

BackgroundWith aging, and as the duration of their dependence on dialysis becomes longer, maintenance hemodialysis patients experience decreased urine volume and lose the need to urinate. It is not known whether lower urinary tract symptoms (LUTS) affect the quality of life (QOL) in maintenance hemodialysis patients. We report an observational study that used validated questionnaires to evaluate LUTS and the influence of LUTS on QOL in a group of maintenance hemodialysis patients.MethodsStable patients who were on maintenance hemodialysis were surveyed with the Overactive Bladder Symptom Score and International Prostate Symptom Score, as the disease-specific validated questionnaires for overactive bladder and benign prostatic hypertrophy, to assess the LUTS and with King’s Health Questionnaire to assess the influence of LUTS on QOL.ResultsThis study included 131 patients with a mean age and hemodialysis duration of 69.1 years and 98.1 months. The disease-specific validated questionnaires found that 20 patients of them experienced LUTS. The mean QOL score of King’s Health Questionnaire was significantly impaired (p < 0.01), and hemodialysis duration was significantly shorter (p < 0.01) in the LUTS patients than in the non-LUTS patients. Single and multiple regression analysis showed that LUTS was independently associated with the QOL score of King’s Health Questionnaire (correlation coefficient 0.292; 95% confidence interval 20.36–89.47; p < 0.01).ConclusionsLUTS exists in maintenance hemodialysis patients and impairs the QOL of them assessed with the validated questionnaires. Urological interventions may contribute to improving the QOL of maintenance hemodialysis patients who experiences LUTS.

Is It Compulsory to Investigate for Erectile Dysfunction in Patients Presenting for Low Urinary Tract Symptoms?

BackgroundCurrent European Association of Urology guidelines suggest investigation of erectile dysfunction (ED) among patients with lower urinary tract symptoms (LUTS) whenever there is a clinical suspicion. ObjectiveTo assess factors predictive of ED, which may drive the need for a clinical assessment in men only presenting for LUTS. Design, setting, and participantsData from 914 men presenting for LUTS at a single-center outpatient clinic and without a previous diagnosis of ED were analyzed. InterventionAll patients completed the International Prostatic Symptom Score (IPSS) and the International Index of Erectile Function—erectile function (IIEF-EF) questionnaires. Outcome measurements and statistical analysisLogistic regression analyses tested potential predictors of ED and severe ED. The accuracy of the predictive models was assessed, and decision curve analyses (DCAs) tested their clinical benefit. Results and limitationsThe median baseline IPSS score was 12 (7–19). IIEF-EF scores suggestive of unreported ED were observed in 503 (55%) patients; of all, 251 (27%) men showed severe ED. At logistic regression analysis, age (odds ratio [OR]: 1.04; p<0.001), IPSS score (OR: 1.04; p<0.001), diabetes mellitus (OR: 2.37; p=0.02), and smoking history (OR 1.36; p=0.03) were associated with unreported ED, after accounting for body mass index, hypertension, other cardiovascular diseases, and dyslipidemia. The same factors were associated with severe ED (all p≤0.03). The predictive model including these variables showed good accuracy for predicting ED (areas under the curve 0.69 and 0.72, respectively). However, DCAs showed no greater clinical benefit regarding identifying which patients should actually be screened for ED using these variables versus screening all patients with LUTS. Conversely, the net clinical benefit of the tested model was higher when predicting severe ED. As a limitation, we could not check prospectively the clinical impact of detecting ED in LUTS patients. ConclusionsGiven the importance of ED in terms of overall men’s health, segregating patients to be investigated or not for ED according to the traditional risk factors did not emerge more clinically useful than screening all patients presenting for LUTS. Patient summaryLower urinary tract symptoms (LUTS) are frequently associated with erectile dysfunction (ED). Patients presenting for LUTS only in the everyday clinical practice should always be screened for ED and managed accordingly.

Effect of fixed dose combinations of different α1-blockers with dutasteride on quality of life in patients of lower urinary tract symptoms with benign prostatic hyperplasia

Background: Fixed dose combination (FDC’s) of α1-blockers and 5α-reductase inhibitors have commonly been used in patients with lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH). This study compared the effect of FDC’s of tamsulosin, alfuzosin and silodosin with dutasteride on quality of life (QoL) in patients of LUTS with BPH.Methods: Ninety-six male patients aged ≥45 years diagnosed with LUTS and BPH were randomized to receive FDC’s of dutasteride with tamsulosin (group 1), alfuzosin (group 2) and silodosin (group 3) over a period of 16 weeks. Quality of life was assessed using International Prostate Symptom Score (IPSS) 8th question, BPH impact index (BII) and modified Patient Perception of Study Medication (PPSM) questionnaire.Results: IPSS 8th question score improved significantly by 61.68%, 57.63% and 63.4% in group 1, 2 and 3 respectively. BPH Impact Index score also improved significantly by 62.95%, 60.13% and 61.82% in group 1, 2 and 3 respectively. All the three treatments were found to be similar in improving the QoL. Majority of patients were satisfied with their treatment and wanted to receive the medication again while a small number of patients were neutral with the study medication. None of the subjects was dissatisfied with any of the treatment.Conclusions: All the FDC’s improved QoL and were found to be satisfactory as per patient perception of study medications.

Affective symptoms and quality of life in patients with voiding or storage dysfunction: Results before and after sacral neuromodulation: A prospective follow-up study.

Sacral neuromodulation (SNM) is an effective treatment for patients with overactive bladder syndrome (OAB) or non-obstructive urinary retention (NOR). These lower urinary tract symptoms (LUTS) are the result of a functional urological cause but often coincide with psychological and/or psychiatric factors. It has been stated that there is an association between LUTS, depression and anxiety disorders. With this study we will investigate whether affective symptoms and quality of life (QoL) improve after successful SNM. All patients eligible for SNM between March 2013 and March 2016, filled out the HADS (Hospital Anxiety and Depression Scale), SF-36 (Short Form-36) and either the International Consultation on Incontinence Modular Questionnaire (ICIQ) on Male/Female Lower Urinary Tract Symptoms (M/F-LUTS), or the OAB-q questionnaire, before and after the test procedure. Symptom improvement of ≥50% was considered as success. Results were analyzed by paired T-tests and the Wilcoxon signed-rank test. In total 95 patients were included. Mean age was 52.1 (SD 13.9). Fifty-six patients (59%) were implanted. Successful OAB patients reported a significant improvement in all domains of OAB-q, health change and affective symptoms. Successful NOR patients showed a significant improvement in voiding symptoms (P = 0.04) and health change (P = 0.03). However, they did not report significant improvement in affective symptoms. QoL and affective symptoms can significantly improve in LUTS patients who are successfully treated with SNM. When divided per indication, a significant improvement in affective symptoms together with QoL was only reported in successful OAB patients and not in successfully treated NOR patients.

Evaluation of ‘Visual prostate symptom score’ in men with benign enlargement of prostate in a tertiary care center in midwestern Nepal

Introduction: Quantification of lower urinary tract symptoms (LUTS) in patients with benign enlargement of prostate (BEP) is required to initiate and regulate treatment. Among many, International Prostate Symptom Score (IPSS) is standard though it is time consuming and difficult to understand by many patients. A recent Visual Prostate Symptom Score (VPSS) which is presumed to be simpler and well understood by patients with lower educational status has been in use.Methods: This is a prospective observational study conducted in Nepalgunj Medical College, Nepalgunj. In a total of 79 patients, 25 patients of LUTS because of other causes were excluded and 54 patients clinically diagnosed with BEP were enrolled for the study over a period of one year. Symptom evaluation was done in all with both IPSS and VPSS and uroflowmetry parameters were also recorded. The IPSS and VPSS were compared with each other and also with uroflowmetry parameters.Results: Mean age of the patients was 67 years and mean prostate volume was 48 gm. The patients who mostly were farmers had median eighth grade of education. Fourteen were illiterates and 40 were literate patients. Significant number of patients required assistance of a medical personnel to complete IPSS (p= &lt;0.001) including those in literate group as well (p= &lt;0.001). Time taken to complete VPSS was significantly less (p= 0.019). Total IPSS correlated with total VPSS ((r= +0.36; p=0.007). There was negative and significant correlation of VPSS with uroflowmeter parameters while IPSS failed to do so.Conclusion: VPSS is an easy and reliable tool to assess symptom severity in cases of BEP presenting with LUTS. It has the added advantage of utility in assessment of LUTS in patients with lower educational status. Moreover, the patients take shorter time to complete the questionnaire. Journal of Society of Surgeons of Nepal, 2015; 18 (2), page: 6-10

The bidirectional relationship between anxiety, depression, and lower urinary track symptoms: A nationwide population-based cohort study

BackgroundEvidence has shown a positive correlation between lower urinary tract symptoms (LUTS) and anxiety/depression, but the direction and strength of the association are still unclear. We aimed to test the bidirectional association between LUTS and anxiety/depression using a longitudinal population database. MethodsUsing claims data obtained from the Taiwan National Health Insurance Research Database, 17,489 patients with LUTS and 34,978 non-LUTS matched controls (cohort 1); and 45,707 patients with anxiety, 19,306 patients with depression, 91,414 non-anxiety, and 38,720 non-depression matched controls (cohort 2) were enrolled between 1999 and 2008. All subjects were followed at least three years or until the date of death or the end of 2011 to estimate the risk of developing anxiety/depression (cohort 1) or LUTS (cohort 2). ResultsAfter controlling for age, gender, and medical comorbidities, LUTS patients were 2.12 (95%CI: 1.95–2.30) and 2.03 (95%CI: 1.76–2.33) times more likely to develop anxiety and depression, respectively. After controlling for age, gender, and medical comorbidities, patients with anxiety and depression were 2.01 (95%CI: 1.88–2.14) and 2.37 (95%CI: 2.13–2.65) times more likely to develop LUTS, respectively. LimitationsThe incidence of anxiety, depression, and LUTS may be under-estimated because only healthcare-seeking subjects were enrolled in our study. ConclusionsOur findings suggested a bidirectional relationship between administrated anxiety/depression and LUTS in the cohorts. Further studies are warranted to clarify the underlying mechanisms.

Evaluation of ‘Visual prostate symptom score’ in men with benign enlargement of prostate in a tertiary care center in midwestern Nepal

&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Quantification of lower urinary tract symptoms (LUTS) in patients with benign enlargement of prostate (BEP) is required to initiate and regulate treatment. Among many, International Prostate Symptom Score (IPSS) is standard though it is time consuming and difficult to understand by many patients. A recent Visual Prostate Symptom Score (VPSS) which is presumed to be simpler and well understood by patients with lower educational status has been in use.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This is a prospective observational study conducted in Nepalgunj Medical College, Nepalgunj. In a total of 79 patients, 25 patients of LUTS because of other causes were excluded and 54 patients clinically diagnosed with BEP were enrolled for the study over a period of one year. Symptom evaluation was done in all with both IPSS and VPSS and uroflowmetry parameters were also recorded. The IPSS and VPSS were compared with each other and also with uroflowmetry parameters.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Mean age of the patients was 67 years and mean prostate volume was 48 gm. The patients who mostly were farmers had median eighth grade of education. Fourteen were illiterates and 40 were literate patients. Significant number of patients required assistance of a medical personnel to complete IPSS (p= &amp;lt;0.001) including those in literate group as well (p= &amp;lt;0.001). Time taken to complete VPSS was significantly less (p= 0.019). Total IPSS correlated with total VPSS ((r= +0.36; p=0.007). There was negative and significant correlation of VPSS with uroflowmeter parameters while IPSS failed to do so.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;VPSS is an easy and reliable tool to assess symptom severity in cases of BEP presenting with LUTS. It has the added advantage of utility in assessment of LUTS in patients with lower educational status. Moreover, the patients take shorter time to complete the questionnaire. &lt;/p&gt;

CORRELATION BETWEEN PCAR WITH IPSS SCORE, QMAX, AND POST VOIDING RESIDUAL URINE AND ITS CUT-OFF VALUE IN DETERMINING BOO IN PATIENTS WITH BPH LUTS

Objective: This study was conducted to determine the correlation between Presume Circle Area Ratio (PCAR) and IPSS score, Qmax, and post voiding residual urine (PVR) and to find PCAR cut-off value in determining the presence Bladder Outlet Obstruction (BOO) in Benign prostatic hyperplasia (BPH) Lower Urinary Tract Symptoms (LUTS). Materials &amp; Methods: This study was observational analytic study with 30 BPH LUTS patients as subjects during the period September 2015 to January 2016. The determined variables were PCAR, IPSS score, Qmax, post voiding residual urine (PVR) and analyzed using the SPSS program v21. Results: There were 30 patients who met the inclusion and exclusion criteria with the mean age of 67.47 years. In the correlation test, there was insignificant correlation between PCAR with IPSS (r=0.138, p=0.467), a significant correlation between PCAR with Qmax (r=0.468, p=0.009), PCAR with PVR (r=0.399, p=0.029), PCAR with BOO (r=0.491, p=0.006) PCAR cutoff value is 0.65 with sensitivity of 69% and specificity of 71%. Conclusion: PCAR has a significant correlation with PVR, Qmax and BOO but no significant with IPSS score. PCAR value &gt;0.65 indicating BOO in BPH LUTS. PCAR can be used as an alternative non-invasive examination in determining the existence of BOO.

Curative effect of testosterone combined with solifenacin for patients with lower urinary tract symptoms in late-onset hypogonadism

Objective To investigate the clinical efficacy and safety of testosterone supplement and M receptor blockers in the treatment of patients with lower urinary tract symptoms(LUTS) in late-onset hypogonadism(LOH). Methods 28 cases diagnosed as LOH with mild to moderate LUTS were collected.They were given testosterone supplementation (oral testosterone undecanoate capsules, 80mg, 2 times/d) and M receptor blocker (oral succinate solifenacin tablet, 5mg, 1 time/d) treatment for 1-3 months.After treatment for 1 month and 3 months respectively, reviewd PSA, serum total testosterone (TT), international prostate of urinary storage symptoms score (urinary storage IPSS), quality of life (QOL) score, international index of erectile function (IIEF-5) score, maximum urinary flow rate (Qmax), residual urine (Ru) and rectal examination (DRE). The improvement of LUTS before and after treatment was evaluated. Results 1 month after treatment, 1 patient was difficult to tolerate the solifenacin side effects and took testosterone supplementation alone.The rest 27 patients were able to take medicine for 3 months.After 1 month and 3 months treatment, the IPSS score had significant differences compared with before treatment[(10.3±2.1)points vs (14.2±3.3) points and (9.42±1.8) points vs (14.2±3.3) points, t=13.67, 14.72, all P<0.05]. After 3 months treatment, the QOL and IIEF-5 scores were (2.1±0.7) points vs (4.3±0.6) points and (16.8±3.6) points vs (11.9±2.5) points, Qmax was (12.5±5.6)mL/s vs (9.8±4.8)mL/s(t=6.42, 5.64, 14.92, all P<0.05), the difference was statistically significant compared with before treatment.There were no significant changes in PSA and RU before and after treatment.All patients had no severe complications such as acute urinary retention. Conclusion Combination of testosterone and testosterone in the treatment of LUTS patients in LOH is safe and effective, and can significantly improve the LUTS and quality of life. Key words: Late-onset hypogonadism; Lower urinary tract symptoms; Testosterone supplement; Solifenacin

New therapeutic strategies for the treatment of male lower urinary tract symptoms.

Male lower urinary tract symptoms (LUTS) are prevalent in the general population, especially in those of advanced age, and are characterized by notable diversity in etiology and presentation, and have been proven to cause various degrees of impairment on quality of life. The prostate has traditionally been regarded as the core cause of male LUTS. As a result, medical treatment aims to provide symptomatic relief and effective management of progression of male LUTS due to benign prostatic enlargement. In this context, α1-blockers, phosphodiesterase-5 inhibitors, and 5α-reductase inhibitors have long been used as monotherapies or in combination treatment to control voiding LUTS. There is accumulating evidence, however, that highlights the role of the bladder in the pathogenesis of male LUTS. Current research interests have shifted to bladder disorders, and medical management is aimed at the bladder. Muscarinic receptor antagonists and the newly approved β3-adrenergic agonist mirabegron aim to alleviate the most bothersome storage LUTS and thus improve quality of life. As voiding and storage LUTS frequently coexist, combination therapeutic strategies with α1-blockers and antimuscarinics or β3-agonists have been introduced to manage symptoms effectively. Anti-inflammatory agents, vitamin D3-receptor analogs, and cannabinoids represent treatment modalities currently under investigation for use in LUTS patients. Furthermore, luteinizing hormone-releasing hormone antagonists, transient receptor-potential channel blockers, purinergic neurotransmission antagonists, Rho-kinase inhibitors, and inhibitors of endothelin-converting enzymes could have therapeutic potential in LUTS management, but still remain in the experimental setting. This article reviews new strategies for the medical treatment of male LUTS, which are dictated by the potential role of the bladder and the risk of benign prostatic hyperplasia progression. Moreover, combination treatments and therapies currently under investigation are also presented.